Orthodontic implants have become increasingly popular in the past few years because of the need for absolute anchorage and the diminishing cooperation patients are exhibiting. Two basic types of implants are available, namely the single screw placed in the dentoalveolar bone between tooth roots and the skeletal miniplate attached to basal bone apical and away from the proximity of the roots.
The advantages of the single screw implant with a variety of head designs, depending on the manufacturer, include ease of placement, which can be performed by an orthodontist, and which is atraumatic and is less expensive. The disadvantages include possible root penetration, poor bony anchorage, limitation on the type of force vectors which can be utilized, bony insertion at an undesirable angle in order to avoid root damage, insertion more apically than desired so as to avoid root damage and the tendency to unscrew if the created moment tends to unwind the screw. Another disadvantage that frequently surfaces, particularly in the mandibular arch, is soft tissue proliferation at the emergence of the implant. The resultant hyperplastic tissue can sometimes completely engulf the exposed end making monthly adjustments difficult. By placing the implant emergence at or near the mucogingival junction, which is often difficult because of root proximity, this undesirable soft tissue response is avoidable.
The advantages of the multiscrew skeletal miniplate include better anchorage and hence larger magnitudes of force application, no or greatly reduced potential for root damage, better ability to withstand all forces in all directions and reduced chance of implant failure. The soft tissue response is much improved because emergence can approximate the mucogingival junction. The disadvantages include cost, more difficult placement and accompanying surgery and longer post-operative recovery. Placement will generally require the skills of an oral surgeon.